Retention suture bridge

ABSTRACT

Apparatus for controlling and distributing the tension of retention sutures used in abdominal surgery has a bridging element that may be placed across the surgical incision underneath the loosely tied suture. The surgeon obtains the desired suture tension by placing the tied suture within a slot in a positive locking capstan that is mounted on the bridging element, and rotating the capstan to take up the slack. An increase in the suture tension caused by swelling of the wound may be released by turning the capstan in the reverse direction.

United States Patent Edwards et al.

[451 Mar. 21, 1972 [54] RETENTION SUTURE BRIDGE [72] Inventors: Leon C.Edwards, Somerville; Harvey B.

Mandel, North Brunswick; Carl R. Tillstrom, East Windsor Twps., MercerCity,

all of NJ.

[73] Assignee: Ethicon, lnc., Somerville, NJ.

22 Filed: on. 20, 1970 [2]] Appl. No.: 82,255

[51] Int. Cl. v ..A61b 17/04 [58] Field of Search ..128/334 R, 335

[56] Relerences Cited UNITED STATES PATENTS 815,264 3/1906 Chambers..128/334 R 1,852,098 4/1932 Anderson ..128/335 3,014,483 12/1961McCarthy ..128/334 R OTHER PUBLICATIONS Broaddus Surgery, Gyne., &Obstet. Vol. 124, Feb. 1967, pp. 359- 361.

Primary Examiner-Dalton L. Truluck Attorney-Robert W. Kell and Robert L.Minier s71 ABSTRACT Apparatus for controlling and distributing thetension of retention sutures used in abdominal surgery has a bridgingelement that may be placed across the surgical incision undemeath theloosely tied suture. The surgeon obtains the desired suture tension byplacing the tied suture within a slot in a positive locking capstan thatis mounted on the bridging element, and rotating the capstan to take upthe slack. An increase in the suture tension caused by swelling of thewound may be released by turning the capstan in the reverse direction.

6 Claims, 12 Drawing Figures PATENTEUHARZI I972 3,650,274

sum 1 BF 3 INVENTORS 5 QTTORNE'Y a PATENTEUMARZI I972 Y sum 2 or 3 w m3owms m M Z. m m2 (/0 f ms yw PATENTEDHARZ] I972 I ,550, 7

SHEET 3 OF 3 ATTORN'E RETENTION SUTURE BRIDGE BACKGROUND OF THEINVENTION Retention sutures (stay sutures) are frequently employed inabdominal and thorasic surgery when the surgeon is concerned with wounddehiscence because of age or condition of the patient. Such sutures areplaced through the skin a distance away from the incision, downwardlythrough the fatty and muscular layers by means of a curved needle, thenupwardly through both layers and the skin at the opposite side of theincision, and tied in a knot to draw the edges of the skin together. Apreferred surgical technique is to apply the suture in a figure-of-eightconfiguration in which the lower loop of the suture surrounds thesevered portions of muscular tissue and the upper loop is completed bytying a knot above the skin layer. In either case the knotted suturecrosses the incision and rests on the sensitive skin adjacent to thewound. As swelling frequently occurs after surgery, it is customary forthe comfort of the patient to provide a device to release and distributethe stress applied as the suture tension increases.

Makeshift devices for use with retention sutures have proliferated assurgeons have tried bridges, stents, cushions, sleeves, splints,bolsters, bars, shields, buffers, rolls, pads, buttons, tubing, pants,bumpers, boots, and booties. Perhaps the most widely used devices in theUnited States are rubber or plastic tubes which are generally availableand easy to use because they can be quickly cut to the desired length.Such tubes have the advantage of simplicity, flexibility, and softness,but the tubing itself can cause skin necrosis and there is no way ofadjusting the suture tension.

Surgeons have also used bridges, shields, and bars in conjunction withretention sutures. Such devices are placed across the wound and theretention suture is tied over it. A suture bridge has the advantage overa tube of better distribution of pressure over the skin surface and actsas a strut thereby preventing cutting as the suture comes through theskin. One such device that is adaptable to varying breadth of theretention suture line is described in Surgery, Gynecology, andObstetrics, Volume 124, pages 359-361, Feb. 1967.

The basic design of suture bridges is important as high arched bridgestip or topple; flat bridges press on the incision; wide bridges obscurethe wound; narrow bridges invite skin necrosis; hard bridges cut intothe skin; and soft bridges buckle. A bridge suitable for one patient maynot be suitable for the next or even for the next or even for the nextretention suture in the same patient. A major disadvantage of mostsuture bridges however, similar to the problem encountered with rubberor plastic tubes, is the inability to adjust suture tension. A suturebridge that will support the suture in such manner that it will not bearon the wound while permitting adjustment of the suture tension followingsurgery is described in U.S. Pat. No. 1,852,098.

In view of the above it will be understood that an object of the presentinvention is to provide an improved surgical suture bridge. Morespecifically it is an object of the invention to provide a bridge withadjustable means to .either increase or decrease suture tension at anytime following placement of the suture by the surgeon.

SUMMARY OF THE INVENTION The suture bridge of the present invention maybe molded of a transparent plastic material in two parts. The bridgingelement has a plurality of openings spaced longitudinally so that whenplaced across the incision after suturing, each end of the suture as itexits through the skin will be in approximate registration with anopening and therefore may pass through the bridge and be tied above alongitudinal slot therein, adapted to receive the suture.

The suture when tied in position above the bridge engages a positivelocking capstan that is mounted on the bridge for rotation. The tensionof the tied suture may be adjusted at any time by rotating the capstanas will be better understood from the following descriptions when readin conjunction with the accompanying drawings wherein:

FIG. 1 shows the suture bridge in place and in locked position;

FIG. 2 is a vertical cross section, thereof and taken along lines 2-2 ofFIG. 1;

FIG. 3 is an enlarged fragment in cross section of FIG. 2 showing thelocking post in elevation;

FIG. 4 is a plan view thereof;

FIG. 5 is a vertical cross section of FIG. 3 taken along lines 5-5;

FIG. 6 is a perspective of the locking post;

FIG. 7 is a plan view similar to FIG. 4 and of the suture placed inposition prior to tightening and locking;

FIG. 8 is a vertical cross section thereof taken along lines 88 of FIG.7;

FIG. 9 shows the surgeon placing the bridge in position after theretention suture has been placed;

FIG. 10 illustrates the appearance of the suture after it is tied, withthe retention bridge in place across the surgical incision;

FIG. 11 shows the surgeon engaging the suture in the positive lockingcapstan; and

FIG. 12 illustrates the manner in which the surgeon can adjust suturetension by rotating the capstan.

Referring first to FIGS. l-3 which best illustrate the construction ofthe bridge element 10, it will be noted that it is constructed with aslightly concave lower surface 11 adapted to conform with the abdomen ofa patient. The bridge 10 has a thickened central portion 12 and a firstcylindrical bore 13 in the upper surface 14 of said thickened portionthat is perpendicular to the longitudinal axis of the bridge. A secondcylindrical bore 15 in the bridge is concentric with said first bore andof smaller diameter. The thickened portion of the bridge and the firstand second bore are transversed by a slot 16 that extends along theupper surface of the bridge parallel to its longitudinal axis. Openings17 are spaced centrally and longitudinally from each end of the bridgetoward the central portion in line with the slot and extend through thebridging element from the upper surface 14 to the lower surface 11.

A positive acting capstan 20 is positioned within the bore 15. Theconstruction of this capstan and its mode of operation will be bestunderstood by referring to FIGS. 4, 5, and 6. The capstan is constructedwith a flange 21 at the upper end and has a cylindrical body portion 22that is received by the bore 15 of the bridging element for slidable androtary motion thereto. The flange at the upper end of the capstan hascogs 23 spaced around the circumference thereof. Both the capstan andcogged flange are bisected by a slot 24 characterized by a V-shapedentrance.

Stop pins 25 are spaced around the circumference of the bore 13 andengage the cogs 23 when the capstan is pressed downwardly toward thelower surface of the bridge. These pins are disengaged when the capstanis pulled upward.

The capstan may be secured within the bore 15 by a bolt 26.

Further details of the present invention are best understood within theframework of its use by the surgeon. Referring now to FIG. 9, there isshown the hand of a surgeon passing one end of a retention suturethrough the bridge. The other end of the suture is passed through anopening chosen so that when the bridge is in position across theincision as shown in FIG. 10, the section of the bridge betweenthe-suture ends closely approximates the suture spacing, i.e., so thatthe openings used to receive the suture 30 are in approximateregistration with the bridge as best shown in FIG. 10. The suture istied by the surgeon to complete a loop above the points of emergence ofthe suture from the skin.

After the suture is properly tied, the surgeon lifts the capstanupwardly in the direction of the arrow in FIG. 8 so that it is free ofthe stop pins 25 and rotates the cogged flange to align the slot 24 inthe capstan with the slot 16 of the bridge. The suture is then laid inthe slot 24 as best shown in FIG. 11 and the capstan is rotatedclockwise as shown in FIGS. 7 and 8 until the tension of the suture isthat desired by the surgeon (see FIG. 12). The capstan is then presseddownward to engage the cogs 23 with the stop pins 25 thus locking thesuture in position.

If the wound should swell thereby increasing suture tension, the surgeonmay relieve the tension by moving the capstan to its upper positionabove the stop pins 25, rotating the capstan in a counterclockwisedirection to unwind the suture and again depressing the capstan toengage the stop pins 25 when the proper tension is approximated.

It will be noted from FIGS. 1 and 2 that the ends of the bridgingelement are turned upwardly which prevents the bridge from cutting intothe skin of the patient. The bridge may be molded from any thermoplasticmaterial such as methyl methacrylate. The preferred material is apolycarbonate resin such as that manufactured by the General ElectricCo. under the trademark Lexan because this material is flexible, hasexceptional clarity and will withstand autoclavmg.

As best illustrated in FIG. 2, the bridge distributes the stressresulting from the tension of the suture over a relatively large skinarea while the appreciable width of the suture and the proximity of thesuture to the surface of the patients body imports lateral stability tothe bridge and prevents it from tipping over.

From the foregoing description of the invention it will be readilyapparent that an improved surgical bridge is made available to thesurgeon that will reduce the incidence of disfiguration by wound scarsand contribute to the comfort of the patient undergoing surgery.

What is claimed is:

l. A surgical apparatus for use in controlling and distributing thetension of transverse retention sutures comprising:

a surgical incision bridging element, having a thickened centralportion;

a cylindrical bore in said thickened portion perpendicular to thelongitudinal axis of said bridging element, said cylindrical bore beingtransversed by a slot extending parallel to said longitudinal axis;

openings spaced centrally and longitudinally beyond each side of saidslot and extending through the bridging element;

a positive locking capstan characterized by a cogged flange at the outerend, positioned within said bore for slideable and rotary motionrelative thereto;

a slot transversing said cogged flange; and,

a stop adjacent the wall of said bore and integral with the bridgingelement, adapted to engage the cogged flange when slideably moved to itsinward position.

2. The surgical apparatus of claim 1 wherein said bridging element ismolded of a transparent plastic material.

3. The surgical apparatus of claim 2 wherein said plastic material isstable at elevated temperatures whereby the apparatus may be repeatedlysterilized by autoclaving.

4. The surgical apparatus of claim 1 wherein the bridging element ischaracterized by a concave lower surface.

5. The surgical apparatus of claim 1 wherein a plurality of stops arepositioned around the circumference of said bore.

6. The surgical apparatus of claim 1 characterized by a V- shapedentrance to the slot transversing the cogged flange, whereby theplacement of a suture in the slot is facilitated.

UNITED STATES PATENT OFFICE I CERTIFICATE OF CORRECTION Patent No.3,650,271 Dated March 21,1972

Inventor(s) Leon C. Edwards; Harvey B. Mandel; Carl R. Tillstrom It iscertified that error appears in the above-identified patent and thatsaid Letters Patent are hereby corrected as shown below:

In Column 1, line #5, "for the next or even for the next or even for thenext retention" should read --for the next or even for the nextretention--.

Signed and sealed this 12th day of September 1972.

(SEAL) Attest:

EDWARD M.FLETCHER ,JR. Attesting Officer ROBERT GOTTSCHALK Commissionerof Patents

1. A surgical apparatus for use in controlling and distributing thetension of transverse retention sutures comprising: a surgical incisionbridging element, having a thickened central portion; a cylindrical borein said thickened portion perpendicular to the longitudinal axis of saidbridging element, said cylindrical bore being transversed by a slotextending parallel to said longitudinal axis; openings spaced centrallyand longitudinally beyond each side of said slot and extending throughthe bridging element; a positive locking capstan characterized by acogged flange at the outer end, positioned within said bore forslideable and rotary motion relative thereto; a slot transversing saidcogged flange; and, a stop adjacent the wall of said bore and integralwith the bridging element, adapted to engage the cogged flange whenslideably moved to its inward position.
 2. The surgical apparatus ofclaim 1 wherein said bridging element is molded of a traNsparent plasticmaterial.
 3. The surgical apparatus of claim 2 wherein said plasticmaterial is stable at elevated temperatures whereby the apparatus may berepeatedly sterilized by autoclaving.
 4. The surgical apparatus of claim1 wherein the bridging element is characterized by a concave lowersurface.
 5. The surgical apparatus of claim 1 wherein a plurality ofstops are positioned around the circumference of said bore.
 6. Thesurgical apparatus of claim 1 characterized by a V-shaped entrance tothe slot transversing the cogged flange, whereby the placement of asuture in the slot is facilitated.